Zenith® Fenestrated AAA Endovascular Graft – General Planning/Sizing Guidelines
General Guidelines for Planning and Sizing the
Zenith® Fenestrated AAA Endovascular Graft
Note: These are general guidelines and should be used only in conjunction with the Planning/Ordering
Chart by physicians who have participated in the Zenith Fenestrated Planning and Sizing Workshop
FENESTRATIONS
1)
Grafts may contain up to a total of 3 fenestrations.
2)
Grafts may include no more than 2 of any one type of fenestration (small, large or
scallop)
3)
Distance between fenestrations must be >5mm (approximately 2 hours of clock
position, depending on graft diameter):
(a)
(b)
(c)
(d)
4)
distance between scallops must by > 2 hours
distance between a fenestration and a scallop at the same stent level must be >
1½ hours
distance between 2 small fenestrations at the same stent levels must be >2
hours.
Distance between a small fenestration and a large fenestration at the same
stent level must be > 1½ hours.
The edge of large and small fenestrations must not extend distal to the lower
fenestration boundary (see following table):
Graft Diameter
24 – 32 mm
34 – 36 mm
Revised March 2007
Lower Fenestration Boundary
One Internal Stent
Two Internal Stents
16 mm
36 mm
21 mm
46 mm
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Zenith® Fenestrated AAA Endovascular Graft – General Planning/Sizing Guidelines
PROXIMAL GRAFT
1)
A proximal graft with 2 internal stents is generally preferred:
+ maximizes available proximal sealing potential
+ allows greater range of fenestration placement
- may compromise body component overlap length
2)
Choose the outside diameter of the graft to be 10 to 15% larger than the proximal
implantation site.
3)
If the implantation site has varying diameters through it’s length, oversize the graft to
ensure good contact with the largest diameter of the implantation site.
4)
Choose a proximal graft length that will place the distal end of the graft between 20 to
35mm above the aortic bifurcation.
DISTAL GRAFT
1)
Plan a minimum 3 stent overlap between the proximal and the distal body grafts,
more if possible.
2)
Body lengths should be chosen so that adequate overlap will be maintained even if the
completed graft takes a curved path out into the aneurysm sac.
3)
The attachment sites for distal implantation are oversized by approximately 15 to 25%
- oversizing can be increased in vessels with diameters greater than 6mm.
4)
The proximal edge of the distal body should be well below the lowest fenestration.
5)
The distal body length should place the contralateral limb position between 5 and
10mm above the aortic bifurcation.
Revised March 2007
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Zenith® Fenestrated AAA Endovascular Graft – General Planning/Sizing Guidelines
IPSILATERAL LEG
(Principles are the same as for standard Zenith Endovascular Graft)
1)
Oversize the distal body ipsilateral leg diameter by 15 to 25% to ensure a good fit
within the vessel.
2)
Graft oversizing in small vessels should be conservative. In larger vessels, more
oversizing is less likely to compromise the lumen.
3)
The length of the integral ipsilateral leg should be chosen to land the distal end just
above the common iliac bifurcation for increased stability and reduced likelihood of
endoleak.
CONTRALATERAL LEG
(Principles are the same as for standard Zenith Endovascular Graft)
1)
Oversize the contralateral leg diameter by 15 to 25% to ensure a good fit within the
vessel.
2)
Graft oversizing in small vessels should be conservative. In larger vessels more
oversizing is less likely to compromise the lumen.
3)
Minimum 1 stent overlap between the contralateral leg and the distal body
contralateral limb; upper limit on overlap is 2 stents and the optimal overlap is 1½
stents.
4)
Plan for the contralateral leg to land just above the common iliac bifurcation for
increases stability and reduced likelihood of endoleak.
Revised March 2007
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Zenith® Fenestrated AAA Endovascular Graft – General Planning/Sizing Guidelines
PROXIMAL FAAA GRAFT LENGTHS
Diameter
(mm)
24 – 32
34 - 36
Diameter
(mm)
24 – 32
34 - 36
Revised March 2007
1 INTERNAL STENT
Total Length
Proximal Sealing Zone
(mm)
(mm)
76
24
91
24
106
24
121
24
84
29
99
29
114
29
129
29
Distal Landing Zone
(mm)
32
47
62
77
32
47
62
77
2 INTERNAL STENTS
Total Length
Proximal Sealing Zone
(mm)
(mm)
94
41
109
41
124
41
107
51
122
51
137
51
Distal Landing Zone
(mm)
33
48
63
33
48
63
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